- The Washington Times - Tuesday, September 8, 2009

Expanding Medicaid eligibility. No more denying insurance coverage to patients with an old back problem or cutting coverage when a healthy patient is diagnosed with cancer.

President Obama can seize on these largely bipartisan proposals Wednesday when he outlines his health care overhaul plan in a rare address to a joint session of Congress.

Despite bipartisan agreement on a number of provisions, health care reform is mired in politics - played out in congressional town-hall meetings across the country in August. The contention centered largely on an evolving $1 trillion public health insurance proposal, which is favored by Democrats and opposed by Republicans.

But the agreement over the easy stuff isn’t likely to land on the books if the tough stuff - namely the public option and how to pay for it - isn’t resolved.

Few stakeholders are willing to predict how the overhaul plans will end up, but many analysts agree that a bill won’t be on the president’s desk before Thanksgiving.

“It’s difficult to predict how it’s going to turn out,” said Ken Johnson, senior vice president at Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry’s lobbying group. “We’re still hopeful for a [bipartisan bill], but we’ve downgraded our prognosis from optimistic to hopeful.”

But the most likely paths include: a push by Democrats to pass the reform bill with a public option through reconciliation - a procedural move to block a filibuster; a scaled-back, piecemeal bill; a trigger option proposed by a high-profile Republican; or the option lawmakers say they would prefer but is becoming less likely: a bipartisan bill. If Democrats turn to reconciliation to pass the public option, the insurance industry changes likely would be removed from the legislation.

Much of the debate will hinge on whether the Senate Finance Committee’s “gang of six” negotiators can come up with a bipartisan solution. The group, which plans to resume face-to-face discussions Tuesday, is expected to propose cooperatives instead of the public option and finance the deal with a new tax on insurance companies that offer the most elite plans.

Chairman Max Baucus, Montana Democrat, floated a preliminary outline of a bill over the weekend, and the group is expected to act on it this week.

Mr. Obama, in a Labor Day address Monday, tried to rally support from unions. He said the public option would “help improve quality and bring down costs.”

“Your voice can change the world,” he told an energetic crowd of thousands at an AFL-CIO Labor Day picnic in Cincinnati. “Your voice can get health care passed.”

Sen. Charles E. Grassley of Iowa, the ranking Republican on the Finance Committee, is pursuing a scaled-down version of reform after a series of town-hall meetings with constituents convinced him that Americans aren’t ready for Congress to take radical action. His plan likely would include reforms to health insurance, including curtailing premium differences by gender, banning lifetime caps on coverage and guaranteeing renewal.

The White House and Sen. Olympia J. Snowe, a moderate Republican from Maine, are discussing her proposal to set a public option “trigger.” The legislation would allow insurance companies a number of years to reduce health care costs. If they don’t meet certain criteria, a public health insurance program would be created.

Although the plan has the potential to generate up to a handful of Republican votes, Democrats such as Sen. Charles E. Schumer of New York have opposed the idea, saying he would support only an immediate solution.

Others say the trigger option is a step in the right direction.

“It gets the ball moving down the field,” said Martin A. Russo, chief executive officer of Cassidy & Associates and a former Democratic congressman from Illinois. “You can’t change the system so dramatically that you create the unease [with the public].”

House Speaker Nancy Pelosi, California Democrat, said last week that the House would not pass a bill without a “robust” public option, and she was backed up by a group of more than 100 other liberal Democrats. Such rhetoric means any proposal to get Republicans on board could cost Mr. Obama liberal support.

The showdown over the public option is likely to take place in the conference between the House and the Senate over the separate pieces of legislation, said Ron Pollack, executive director of Families USA, a liberal health advocacy group.

Until then, confusion is driving the debate.

Republicans interested in killing the plans are pressuring Mr. Obama - who earlier wanted to leave the details up to Congress - to clarify his vision of reform.

Those who watch his address to Congress on Wednesday will leave “knowing exactly where the president stands,” White House spokesman Robert Gibbs said Sunday on ABC’s “This Week.”

Analysts say the president would be best served by outlining how the reform proposals would impact the typical family’s health care coverage.

Mr. Obama “has to become teacher in chief,” said Ralph G. Neas, chief executive officer of the National Coalition on Health Care, an advocacy group. “He has got to have a kitchen-table discussion with the American people.”

Public support for a government role in health care appears to be falling.

A recent CBS poll found that about 47 percent of Americans think the government would do better than private insurers at controlling costs, down from 59 percent in June.

The lack of support could be attributed to confusion about the plans.The same poll found that 60 percent of Americans don’t think Mr. Obama has given them a clear idea of reform, and another two-thirds are confused about what the legislation proposes.

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